Fibrocalculous pancreatic diabetes (FCPD) is a cause of diabetes seen mainly in developing countries. The study was carried out to observe the prevalence of pancreatic calculi among diabetic subjects attending the outpatient department of BIRDEM and to determine their clinical characteristics. An observational study was carried out at the under thirty (18-30 years) clinic of outpatient department , BIRDEM. Four thousand seven hundred and twenty five subjects were studied who reported to the clinic as newly detected diabetes during the period of 2000 to 2007. All subjects were screened for pancreatic calculi by plain X-Ray abdomen at the 1st visit. Among the total 4725 subjects studied 509 (10.77%) were found to have pancreatic calculi. Mean age of the subjects with pancreatic calculi was 23.02 years. Among them 53% were male, 69.7% had body mass index (BMI) below normal (<18.5 kg/ mÆ) and 27.25% had positive family history of diabetes. An increasing trend was observed in BMI in successive years. Among the subjects with pancreatic calculi 51 (10%) subjects had ketonuria at the time of diagnosis. Subjects with pancreatic calculi present ed with diabetes in early twenties. A good percentage of subjects had family history of diabetes. Though most of them w ere lean, but it was observed that there was an increasing trend of BMI among the under thirty diabetic subjects presenting with pancreatic calculi.

Epidemiology and determinants of diabetes in Pakistan have peculiar combination of risk factors. Strong gene and environment interplay along with in-utero programming in context of low birth weight and gestational diabetes are the main contributors of a high prevalence of type 2 diabetes in Pakistan. The real burden of diabetes is due to its chronic complications leading to increased morbidity and mortality. The unique combination of various risk factors necessitates research studies to make appropriate risk assessment tools to control this diabetes pandemic. Better understanding of aetio-pathological genetic and environmental factors are suggesting prevention should begin much before the start of disease process and interventions in high-risk subjects alone will not be sufficient. It is necessary to initiate population based programmes for primary prevention of diabetes including a range of activities targeted at different age groups from fetal life to old age. Synchronized and coordinated efforts from public and private sectors are needed to combat this mammoth health and economic issue.

Use of pictorial advice to promote compliance to diet and drugs among illiterate and migrant patients

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M Daghio, G Fattori, AV Ciardullo

Illiterate people are at high risk for inappropriate drug use. We aimed at enabling diabetic patients who were illiterate and/or migrants to understand diet and drugs prescription through the use of Icons. We evaluated two communication tools among 40 migrant patients who were unable to read and speak Italian and had to understand medical prescriptions either by being assisted by a health care provider or by looking at the study tools. Ninety-six percent subjects with study tools and 46% subjects with usual prescription plus operator's aid understood the prescription (P<0.01). At follow up, 90% with study tools vs 60% with usual prescription were still compliant and took drugs appropriately (P<0.01). By using the pictogram , diet and drug advice was simplified , consultation time was accelerated by using pictogram and patient 's compliance was improved.